SCOTT SONNER and SANDRA CHEREB, Associated Press

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Surgeons at Renown Regional Medical Center have treated victims in a series of deadly tragedies in recent years, including a horrific crash at the Reno Air Races, a fiery Amtrak accident, a shooting rampage at a pancake restaurant and a murder-suicide at a middle school just two months ago.

This week, they found themselves fighting to try to save the lives of two of their own after a California man opened fire with a 12-gauge shotgun in the examination room area of a urology clinic. One doctor was killed, another critically wounded and a third person seriously injured by the shotgun blasts.

Victims were rushed to an emergency room in the Renown Regional Medical Center campus after the shooting, carried out by a gunman who witnesses said warned patients and their children in a waiting area to “get out.”

“Unfortunately our community has experienced yet another tragedy,” Renown Regional Medical Center CEO Kris Gaw said Wednesday. “This is something that has hit our medical community, not just Renown. It happened on our own doorstep.”

Police identified the slain doctor as Charles G. Gholdoian, 46, a urologist at Urology Nevada. His colleague, Dr. Christine Lajeunesse, was conscious Wednesday but remained in critical condition at Renown.

Lajeunesse and Shawntae Spears, 20, who was accompanying a family member on a doctor visit, each was shot once. Spears’ condition improved Wednesday from critical to serious, the hospital said.

Detectives have not been able to establish a motive or relationship between the gunman and the victims. Investigators carried out a search warrant at his home in Lake Almanor, Calif., a small community about 130 miles north of Reno.

Plumas County Sheriff Greg Hagwood said the man was a long-time resident of the community and lived alone.

Reno Deputy Police Chief Mac Venzo said police don’t know yet whether the gunman had been a patient of the urologist killed or knew any of the victims. He apparently calmly entered the building, went up to the third floor and began shooting in the examination room area.

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“The fact the shooter went through the first and second floor, made his way to the third floor of the building, would indicate to me it is not a random event,” Venzo said. He said they have tentatively identified the killer but were withholding his name because they’ve been unable to reach his next of kin.

Police say there were about 100 people in the office building when authorities were alerted at 2:05 p.m. Tuesday about an “active shooter.”

Vitalis Ozoude, a state auditor, was in the reception area of Urology Nevada with his wife and 3-year-old son waiting for his child’s appointment when the gunman walked in and eventually told them and others to leave.

“I don’t think he meant to kill everybody because if he did he had ample opportunity to do that,” Ozoude told The Associated Press. He said the dozen or so people in the waiting room didn’t immediately react to the sight of a man carrying the gun because he seemed calm.

“He looked like he belonged. I thought he worked there, and he was just getting a gun from his car or taking it to his office,” he said.

The shooting comes nearly two months after a 12-year-old boy opened fire at Sparks Middle School, killing a math teacher and himself. Two students wounded in the schoolyard shooting were treated at Renown, the largest hospital in northern Nevada and home to the region’s only trauma center.

Dr. Michael Morkin, Renown’s incoming chief of staff and senior emergency room surgeon, was friends of both of the physicians who were shot.

Morkin also was in charge of Renown’s ER when a string of tragedies began in June 2011 with the Amtrak crash that killed six and injured 30 in the desert 70 miles east of Reno.

Three months later, he and his staff were back at it when five died and seven were wounded in a Labor Day shooting at an IHOP in Carson City. Two weeks later, a plane crash near the grandstand at Reno Stead Airport killed 11 and injured 70 more — most of them treated at Renown.

Morkin will never forget when a nurse poked his head into the room that Friday afternoon of the air races and said, “Mike, we have mass casualties.”

“We’ve done way too many of these things recently,” Morkin told reporters at a news conference Wednesday at police headquarters.

Reno Deputy Police Chief Tom Robinson said chaplains, counselors and other victim services experts were called to the most recent scene immediately to help provide assistance to witnesses, family members and others traumatized by the shooting.

“A lot of them work here. They deal with trauma, obviously, they’re in the medical field,” Robinson said. “But when it hits home like that, it’s a whole another level.”